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Arterial Compression of the Trigeminal Nerve at the Pons in Patients with Trigeminal Neuralgia

Peter J. Jannetta

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Introduction

Trigeminal neuralgia

Peter J. Jannetta

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Arterial Compression of the Trigeminal Nerve at the Pons in Patients with Trigeminal Neuralgia

Peter J. Jannetta

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Complications from Microsurgical Treatment of Tic Douloureux

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Gross (Mesoscopic) Description of the Human Trigeminal Nerve and Ganglion

Peter J. Jannetta

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Trigeminal neuralgia

Peter J. Jannetta

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The two-stage excision of huge acoustic neurinomas

Peter E. Sheptak and Peter J. Jannetta

✓ Total removal of huge acoustic neurinomas was carried out in 23 patients by means of a two-stage suboccipital transmeatal approach with microsurgical technique. There was no operative mortality. Good results were obtained in 18 (78%) of the patients who have returned to normal activities or full-time employment. Five patients (22%) have residual preoperative neurological deficits causing a reduced level of activity. All of these, except one, are able to care for themselves. None of the patients has had any further significant neurological deficit caused by the operative procedures. Anatomical integrity of the facial nerve was maintained in 17 patients (74%). Surgical technique, operative morbidity, and results are thoroughly discussed. The potential advantages of this technique are stressed.

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Hyperactive rhizopathy of the vagus nerve and microvascular decompression

Case report

Daniel K. Resnick and Peter J. Jannetta

✓ A 37-year-old woman underwent microvascular decompression of the superior vestibular nerve for disabling positional vertigo. Immediately following the operation, she noted severe and spontaneous gagging and dysphagia. Multiple magnetic resonance images were obtained but failed to demonstrate a brainstem lesion and attempts at medical management failed. Two years later she underwent exploration of the posterior fossa. At the second operation, the vertebral artery as well as the posterior inferior cerebellar artery were noted to be compressing the vagus nerve. The vessels were mobilized and held away from the nerve with Teflon felt. The patient's symptoms resolved immediately after the second operation and she has remained symptom free. The authors hypothesize that at least one artery was shifted at the time of her first operation, or immediately thereafter, which resulted in vascular compression of the vagus nerve. To the authors' knowledge, this is the first reported case of a hyperactive gagging response treated with microvascular decompression. The case also illustrates the occurrence of a possibly iatrogenic neurovascular compression syndrome.

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Hemifacial Spasm

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A nerve stimulator for the cerebellopontine angle

Technical note

Charles W. Morgan and Peter J. Jannetta

✓ A fine-tipped bipolar nerve-stimulator probe has been developed and has proved especially useful in intracranial surgery of the cranial nerves.